治消渴。消渴，即西医所谓糖尿病，忌食甜物。
生山药（一两） 生黄 （五钱） 知母（六钱） 生鸡内金（二钱，捣细） 葛根（钱半） 五味子（三钱）
天花粉（三钱）
消渴之证，多由于元气不升，此方乃升元气以止渴者也。方中以黄 为主，得葛根能升元气。而又佐以
山药、知母、花粉以大滋真阴。使之阳升而阴应，自有云行雨施之妙也。用鸡内金者，因此证尿中皆含有糖质，
用之以助脾胃强健，化饮食中糖质，为津液也。用五味者，取其酸收之性，大能封固肾关，不使水饮急于下趋也。
方书消证，分上消、中消、下消。谓上消口干舌燥，饮水不能解渴，系心移热于肺，或肺金本体自热不
能生水，当用人参白虎汤；中消多食犹饥，系脾胃蕴有实热，当用调胃承气汤下之；下消谓饮一斗溲亦一斗，
系相火虚衰，肾关不固，宜用八味肾气
丸。
白虎加人参汤，乃《伤寒论》治外感之热，传入阳明胃腑，以致作渴之方。方书谓上消者宜用之，此借用
也。愚曾试验多次，然必胃腑兼有实热者，用之方的。中消用调胃承气汤，此须细为斟酌，若其右部之脉滑而
且实，用之犹可，若其人饮食甚勤，一时不食，即心中怔忡，且脉象微弱者，系胸中大气下陷，中气亦随之下
陷，宜用升补气分之药，而佐以收涩之品与健补脾胃之品，拙拟升陷汤后有治验之案可参观。若误用承气下之，
则危不旋踵。至下消用八味肾气丸，其方《金匮》治男子消渴，饮一斗溲亦一斗。而愚尝试验其方，不惟治男
子甚效，即治女子亦甚效。曾治一室女得此证，用八味丸变作汤剂，按后世法，地黄用熟地、桂用肉桂，丸中
用几两者改用几钱，惟茯苓、泽泻各用一钱，两剂而愈。后又治一少妇得此证，投以原方不效，改遵古法，地
黄用干地黄（即今生地），桂用桂枝，分量一如前方，四剂而愈。此中有宜古宜今之不同者，因其证之凉热，
与其资禀之虚实不同耳。
消渴证，若其肺体有热，当治以清热润肺之品。若因心火热而铄肺者，更当用清心之药。若肺体非热，因腹
中气化不升，轻气即不能上达于肺，与吸进之养气相合而生水者，当用升补之药，补其气化，而导之上升，此
拙拟玉液汤之义也。然消渴之证，恒有因脾胃湿寒、真火衰微者，此肾气丸所以用桂、附。而后世治消渴，亦
有用干姜、白术者。尝治一少年，咽喉常常发干，饮水连连，不能解渴。诊其脉微弱迟濡。投以四君子汤，加
干姜、桂枝尖，一剂而渴止矣。又有湿热郁于中焦作渴者，苍柏二妙散、丹溪越鞠丸，皆可酌用。
邑人某，年二十余，贸易津门，得消渴证。求津门医者，调治三阅月，更医十余人不效，归家就医于愚。
诊其脉甚微细，旋饮水旋即小便，须臾数次。投以玉液汤，加野台参四钱，数剂渴
见止，而小便仍数，又加萸肉五钱，连服十剂而愈。
生山药（一两） 生黄芪（五钱） 知母（六钱） 生鸡内金（二钱，捣碎成细末） 葛根（一钱半） 五味子（三钱） 天花粉（三钱）
消渴这种病症，多由于元气不能上升所致，这个方剂是提升元气以止渴的。方中以黄芪为主药，配合葛根能够升提元气。又辅以山药、知母、天花粉来大量滋养真阴。使得阳气上升而阴液随之应和，自然有云行雨施般的奇妙效果。使用鸡内金的原因，是因为此证患者的尿液中含有糖分，用它来帮助脾胃强健，将饮食中的糖分转化为津液。使用五味子的原因，是取其酸收的性质，能极大地封固肾关，防止水饮急于向下流失。
医书中关于消证的记载，分为上消、中消、下消三种。认为上消表现为口干舌燥，喝水不能解渴，是由于心火移热于肺，或者肺金本体自身发热不能生水，应当用人参白虎汤；中消表现为吃得多仍然饥饿，是由于脾胃蕴积实热，应当用调胃承气汤攻下；下消表现为喝一斗尿也排出一斗，是由于相火虚衰，肾关不固，适宜用八味肾气丸。
白虎加人参汤，出自《伤寒论》，是治疗外感热邪传入阳明胃腑，导致口渴的方剂。医书说上消适宜使用它，这是借用此方。我曾多次试验，但必须是胃腑兼有实热的情况，使用才确切有效。中消使用调胃承气汤，这需要仔细斟酌，如果患者右部脉象滑且实，使用还可以；如果其人进食频繁，一时不吃就心中悸动不安，且脉象微弱，这是胸中大气下陷，中气也随之陷下，应当使用升补气分的药物，并佐以收敛固涩的药物以及健补脾胃的药物，我在拙作《升陷汤》后有治疗验证的案例可供参考。如果误用承气汤攻下，则危险立刻到来。至于下消使用八味肾气丸，该方出自《金匮要略》，治疗男子消渴，喝一斗尿也排出一斗。而我曾试验过这个方子，不仅治疗男子非常有效，治疗女子也非常有效。曾治疗一位未婚女子患此证，将八味丸改为汤剂，按照后世的方法，地黄用熟地黄，桂枝用肉桂，丸剂中用几两改为汤剂中用几钱，只有茯苓、泽泻各用一钱，服用两剂就好了。后来又治疗一位少妇患此证，投用原方无效，改为遵循古法，地黄用干地黄（即现在的生地黄），桂枝用桂枝，分量完全像前面的方子一样，服用四剂就好了。这里面有适合古代方法和现代方法的不同之处，是因为病症的寒热性质，以及体质禀赋的虚实不同罢了。
消渴病，如果肺体有热，应当用清热润肺的药物来治疗。如果是因心火炽盛灼伤肺脏引起的，更应当使用清心的药物。如果肺体没有热，是因为腹部气化功能不能上升，轻清之气就不能上达于肺，与吸入的氧气结合生成津液，应当使用升补的药物，补益其气化功能，并引导其上升，这就是我拟定玉液汤的宗旨。然而消渴病，常有因脾胃湿寒、真火衰微导致的，这就是肾气丸中使用桂枝、附子的原因。而后世治疗消渴，也有使用干姜、白术的。曾治疗一个少年，咽喉常常发干，连连饮水，不能解渴。诊察他的脉象微弱迟濡。投用四君子汤，加入干姜、桂枝尖，一剂后口渴就停止了。又有湿热郁结在中焦导致口渴的，苍柏二妙散、丹溪越鞠丸，都可以酌情使用。
本县有个姓某的人，二十多岁，在天津经商，得了消渴病。求治于天津的医生，调理了三个月，换了十几个医生都没有效果，回家后找我医治。诊察他的脉象非常微细，刚喝水随即小便，一会儿好几次。投用玉液汤，加入野台参四钱，服用几剂后口渴逐渐停止，但小便次数仍然很多，又加入山茱萸五钱，连续服用十剂后痊愈。
Treats Xiao Ke (Wasting-Thirst Syndrome). Xiao Ke is what Western medicine calls diabetes mellitus; sweet foods should be avoided.
Raw Dioscoreae Rhizoma (Shanyao) (30g), Raw Astragali Radix (Huangqi) (15g), Anemarrhenae Rhizoma (Zhimu) (18g), Raw Endothelium Corneum Gigeriae Galli (Jineijin) (6g, crushed to fine powder), Puerariae Radix (Gegen) (4.5g), Schisandrae Fructus (Wuweizi) (9g), Trichosanthis Radix (Tianhuafen) (9g).
The syndrome of Xiao Ke is mostly due to the failure of Yuan Qi (Primordial Qi) to ascend. This formula ascends Yuan Qi to stop thirst. In the formula, Huangqi serves as the principal herb; combined with Gegen, it can ascend Yuan Qi. Furthermore, it is assisted by Shanyao, Zhimu, and Tianhuafen to greatly nourish True Yin. This allows Yang to ascend while Yin responds, resulting in the miraculous effect akin to clouds moving and rain falling. Jineijin is used because this condition involves sugar content in the urine; it helps strengthen the Spleen and Stomach to transform the sugar in food into Jin Ye (Body Fluids). Wuweizi is used for its sour and astringent nature, which strongly seals the Kidney gate, preventing fluids from rushing downward.
Medical texts classify Xiao Zheng (Wasting-Thirst Manifestations) into Upper, Middle, and Lower Xiao. It is stated that Upper Xiao presents with dry mouth and tongue, where drinking water does not quench thirst, caused by Heart heat transferring to the Lung, or the Lung Metal itself being hot and unable to generate Water. Ren Shen Bai Hu Tang (Ginseng and White Tiger Decoction) should be used. Middle Xiao presents with excessive eating yet persistent hunger, caused by excess heat accumulating in the Spleen and Stomach; Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) should be used to purge. Lower Xiao presents with drinking one dou and urinating one dou, caused by deficiency and decline of Ministerial Fire and insecurity of the Kidney gate; Ba Wei Shen Qi Wan (Eight-Ingredient Kidney Qi Pill) is suitable.
Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is a formula from Shang Han Lun (Treatise on Cold Damage) for treating thirst caused by external pathogenic heat transmitting to the Yangming Stomach Fu organ. Medical texts state it is suitable for Upper Xiao; this is an borrowed application. I have tested it many times, but it must be used when there is concurrent excess heat in the Stomach Fu organ to be effective. For Middle Xiao using Tiao Wei Cheng Qi Tang, careful consideration is required. If the pulse at the right position is slippery and full, it may be used. However, if the patient eats frequently and experiences palpitations when not eating for a short time, and the pulse is weak and faint, this indicates sinking of the Da Qi (Great Qi) in the chest, with Zhong Qi (Middle Qi) sinking along with it. One should use herbs that ascend and tonify Qi in the Qi division, assisted by astringent herbs and herbs that strengthen and tonify the Spleen and Stomach. Cases demonstrating efficacy are recorded after my Lifting Qi Decoction (Sheng Xian Tang) for reference. Misusing Cheng Qi formulas to purge would lead to immediate danger. Regarding Lower Xiao using Ba Wei Shen Qi Wan, the formula in Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet) treats male Xiao Ke, drinking one dou and urinating one dou. I have tested this formula and found it highly effective not only for men but also for women. I once treated an unmarried young woman with this condition, modifying Ba Wei Wan into a decoction. Following later generations' methods, Shu Di Huang (Prepared Rehmanniae Radix) was used instead of Di Huang, and Rou Gui (Cinnamon Bark) instead of Gui Zhi. The dosage in liang for the pill was converted to qian for the decoction, except for Fu Ling (Poria) and Ze Xie (Alisma), each used at 3g. After two doses, she recovered. Later, I treated a young married woman with this condition; the original formula was ineffective. I then followed ancient methods: Gan Di Huang (Dried Rehmanniae Radix, i.e., current raw Sheng Di Huang) and Gui Zhi (Cinnamon Twig) were used, with dosages identical to the previous prescription. She recovered after four doses. There are differences between applying ancient and modern methods here, depending on the cold-heat nature of the condition and the deficiency-excess constitution of the individual.
For Xiao Ke syndrome, if the Lung tissue has heat, treat with herbs that clear heat and moisten the Lung. If caused by Heart fire scorching the Lung, even more so should Heart-clearing herbs be used. If the Lung tissue is not hot, but due to the failure of abdominal Qi transformation to ascend, light Qi cannot reach the Lung to combine with inhaled oxygen to generate fluids, one should use ascending and tonifying herbs to supplement Qi transformation and guide it upward. This is the rationale behind my proposed Yu Ye Tang (Jade Fluid Decoction). However, Xiao Ke cases often arise from Spleen-Stomach damp-cold and decline of True Fire; this is why Gui Zhi and Fu Zi are used in Shen Qi Wan. Later generations also used Gan Jiang (Dried Ginger) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) to treat Xiao Ke. I once treated a youth whose throat was constantly dry, drinking repeatedly without relief. His pulse was weak, slow, and soggy. I prescribed Si Jun Zi Tang (Four Gentlemen Decoction) with added Gan Jiang and Gui Zhi Jian (tips of Cinnamon Twig). After one dose, the thirst stopped. In cases where damp-heat stagnates in the Middle Jiao causing thirst, Cang Bo Er Miao San (Two Marvels Powder with Atractylodes and Phellodendron) or Danxi Yue Ju Wan (Danxi's Relieving Depression Pill) can be used酌情 (as appropriate).
A certain person from my county, in his twenties, engaged in trade in Tianjin, contracted Xiao Ke. He sought treatment from doctors in Tianjin; after three months of regulation and changing over ten physicians without effect, he returned home to seek my treatment. His pulse was very minute and fine; he drank water and immediately urinated, several times in a short period. I administered Yu Ye Tang with added Ye Tai Shen (Wild Taishan Ginseng) 12g. After several doses, the thirst gradually ceased, but urination remained frequent. I then added Shan Zhu Yu (Corni Fructus) 15g. After continuous administration for ten doses, he was cured.